Holly, one thing that has worked for us is a policy that the nurse must have documentation to substantiate a med prior to it being initiated. When the nurse feels a psychotropic was needed, the nurse use to have to have it approved by the DON before the order was written (unless it was an emergency situation). When the nurse had to bug the DON, they made sure it was for just cause (or the DON was liable to go off on them). Also, if the doc wrote an order without a proper Dx, the nurse had it clarified before sending the order to pharmacy. If the doc had left already, he got called. Nothing ticks off a doc more than being paged right after he leaves the facility. After awhile, they get the clue to write complete orders. Also, we use triplicate orders. One stays in the chart, one goes to pharmacy, and I get a copy. I go thru the orders and check for things that could indicate a COC. When going thru the orders, I separate out orders that pertain to other disciplines and give them out so that they can documented on them. (SW gets psych med orders, tx nurse gets any tx orders written, dietitian gets any orders for diet changes or appetite stimulant med orders, etc.)---------------Mike
--- "Holly Sox, RN, RAC-C" <[EMAIL PROTECTED]> wrote: > Hi, Group, > One citation we received on Survey was for > antipsychotic use without the appropriate dx. I have > really been tearing my hair out with psychotropic > meds in general since starting here a year ago. I > have developed a letter to send to MD when > antipsychotic is initiated without the proper dx as > well as when I find one already on the med without > dx. I suggested implementing a policy of not > starting antipsychotic med until the form was > completed by the physician, but DON and > Administrator both said they felt uncomfortable with > a policy of not following a physician's order. > > But, is that any different from not following any > other inappropriate order without clarification??? > For example, I wouldn't start IVF at 300 cc/hour on > a CHF patient, just because the doctor ordered it. > > Could any of you who are "lurking" surveyors (Yeah, > you, MR), send me some guidance (along with links to > supporting regulations, etc)? Also, what are other > facilities doing as far as P/P for antipsychotic > meds? > > Thanks! > > Holly > Holly F. Sox, RN, RAC-C > Clinical Editor > > www.careplans.com [EMAIL PROTECTED] > __________________________________ Do you Yahoo!? New Yahoo! Photos - easier uploading and sharing. http://photos.yahoo.com/ /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
